Healthcare Provider Details

I. General information

NPI: 1255370334
Provider Name (Legal Business Name): DAVID BROUMANDI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 10/27/2023
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15031 RINALDI ST
MISSION HILLS CA
91345-1207
US

IV. Provider business mailing address

PO BOX 25689
COLORADO SPRINGS CO
80936-5689
US

V. Phone/Fax

Practice location:
  • Phone: 818-898-4530
  • Fax: 719-591-2745
Mailing address:
  • Phone: 818-898-4530
  • Fax: 719-591-2745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberA76646
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: